Reducing Tobacco Use and Secondhand Smoke Exposure: Incentives and Competitions to Increase Smoking Cessation Among Workers

Worksite-based incentives and competitions to reduce tobacco use among workers offer rewards to individual workers and to teams as a motivation to participate in a cessation program or effort.

Rewards can be provided for participation, for success in achieving a specified behavior change, or for both.

Types of rewards may include guaranteed financial payments, lottery chances for monetary or other prizes, and return of self-imposed payroll withholdings.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force finds insufficient evidence to determine whether or not worksite-based incentives and competitions alone work to reduce tobacco use among workers. Evidence is considered insufficient because only one study of least suitable design was identified in this review.

The Task Force recommends worksite-based incentives and competitions when combined with additional interventions to support individual cessation efforts based on strong evidence of effectiveness in reducing tobacco use among workers.

Results from the Systematic Review

Worksite-based Incentive Programs when Implemented Alone to Reduce Tobacco Use among Workers

Only one study qualified for this review so conclusions could not be drawn.

Worksite-based Incentives and Competitions When Combined with Additional Interventions to Reduce Tobacco Use among Workers

Twelve studies qualified for the review.

One group randomized trial of 32 worksites found a reduction in self-reported tobacco use of 2.1 percentage points (p=0.03) among workers in worksites with a smoking cessation program and self-imposed payroll withholdings.

A subset of five studies evaluated a similar combination of interventions (including at a minimum, an incentive, a worksite-based tobacco cessation group, and educational materials or activities). In these studies, tobacco quit rates increased by a median of 10 percentage points.

The median quit rate achieved by program participants was 21%.

The median period of follow-up was 12 months.

Interventions that were combined with incentives and competitions included:

Client education

Smoking cessation groups

Self-help cessation materials

Telephone cessation support

Workplace smoke-free policies

Social support networks

Individual rewards ranged from $10 to $237.

Lottery prizes ranged from $40 to $500.

Studies included in this review were conducted in the United States in:

Manufacturing plants, healthcare facilities, government offices, a university, chemical plants, and an ambulance service

Companies or worksites with more than 100 employees

Urban and suburban settings

The presence of an incentive or competition was not associated with a consistent increase in participation in worksite tobacco programs in the studies considered in this review; however participation rates were high in most of the intervention and comparison study arms.

A review of the economic effectiveness of this intervention was conducted. Due to inconsistencies in study designs strong conclusions about cost savings cannot be substantiated.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to tobacco use and secondhand smoke exposure.

Read other Community Guide publications about Reducing Tobacco Use and Secondhand Smoke Exposure in our library.

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Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Reducing tobacco use and secondhand smoke exposure: incentives and competitions to increase smoking cessation among workers. www.thecommunityguide.org/tobacco/incentives.html. Last updated: MM/DD/YYYY.